Background: The existing metrics of malaria transmission are limited in sensitivity under low transmission intensity.
Robust surveillance systems are needed as interventions to monitor reduced transmission and prevention of rapid
reintroduction. Serological tools based on antibody responses to parasite and vector antigens are potential tools for
transmission measurements. The current study sought to evaluate antibody responses to Anopheles gambiae
salivary gland peptide (gSG6- P1), as a biomarker of human exposure to Anopheles bites, in different transmission
settings and seasons. The comparison between anti-MSP-119 IgG immune responders and non-responders allowed
exploring the robustness of the gSG6-P1 peptide as a surveillance tool in an area of decreasing malaria
transmission.
Methods: Total IgG levels to gSG6-P1 were measured in an age-stratified cohort (< 5, 5–14 and ≥ 15 years) in a
total of 1,366 participants from three localities in western Kenya [Kisii (hypoendemic), Kakamega (mesoendemic),
and Kombewa (hyperendemic)] including 607 sera that were additionally tested for MSP-119 specific responses
during a low and a high malaria transmission seasons. Antibody prevalence and levels were compared between
localities with different transmission intensities. Regression analysis was performed to examine the association
between gSG6-P1 and MSP-119 seroprevalence and parasite prevalence.
Result: Seroprevalence of gSG6-P1 in the uphill population was 36% while it was 50% valley bottom (χ2 = 13.2,
df = 1, p < 0.001). Median gSG6-P1 antibody levels in the Valley bottom were twice as high as that observed in the
uphill population [4.50 vs. 2.05, p < 0.001] and showed seasonal variation. The odds of gSG6-P1 seropositives having
MSP-119 antibodies were almost three times higher than the odds of seronegatives (OR = 2.87, 95% CI [1.977,
4.176]). The observed parasite prevalence for Kisii, Kakamega and Kombewa were 4%, 19.7% and 44.6% whilst the
equivalent gSG6-P1 seroprevalence were 28%, 34% and 54%, respectively.
Conclusion: The seroprevalence of IgG to gSG6-P1 was sensitive and robust in distinguishing between hypo, meso
and hyper transmission settings and seasonal fluctuations.

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Article published in Malaria Journal 2012. Also available at www.malariajournal.com/content/11/1/318